Changes in first-line cART regimens and short-term clinical outcome between 1996 and 2010 in The Netherlands.
<h4>Objectives</h4>Document progress in HIV-treatment in The Netherlands since 1996 by reviewing changing patterns of cART use and relating those to trends in patients' short-term clinical outcomes between 1996 and 2010.<h4>Design and methods</h4>1996-2010 data from 10,2...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2013-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0076071 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849724465538138112 |
|---|---|
| author | Mikaela Smit Colette Smit Suzanne Geerlings Luuk Gras Kees Brinkman Timothy B Hallett Frank de Wolf Athena Observational Cohort |
| author_facet | Mikaela Smit Colette Smit Suzanne Geerlings Luuk Gras Kees Brinkman Timothy B Hallett Frank de Wolf Athena Observational Cohort |
| author_sort | Mikaela Smit |
| collection | DOAJ |
| description | <h4>Objectives</h4>Document progress in HIV-treatment in The Netherlands since 1996 by reviewing changing patterns of cART use and relating those to trends in patients' short-term clinical outcomes between 1996 and 2010.<h4>Design and methods</h4>1996-2010 data from 10,278 patients in the Dutch ATHENA national observational cohort were analysed. The annual number of patients starting a type of regimen was quantified. Trends in the following outcomes were described: i) recovery of 150 CD4 cells/mm(3) within 12 months of starting cART; ii) achieving viral load (VL) suppression ≤1,000 copies/ml within 12 months of starting cART; iii) switching from first-line to second-line regimen within three years of starting treatment; and iv) all-cause mortality rate per 100 person-years within three years of starting treatment.<h4>Results</h4>Between 1996 and 2010, first-line regimens changed from lamivudine/zidovudine-based or lamivudine/stavudine-based regimens with unboosted-PIs to tenofovir with either emtricitabine or lamivudine with NNRTIs. Mortality rates did not change significantly over time. VL suppression and CD4 recovery improved over time, and the incidence of switching due to virological failure and toxicity more than halved between 1996 and 2010. These effects appear to be related to the use of new regimens rather than improvements in clinical care.<h4>Conclusion</h4>The use of first-line cART in the Netherlands closely follows changes in guidelines, to the benefit of patients. While there was no significant improvement in mortality, newer drugs with better tolerability and simpler dosing resulted in improved immunological and virological recovery and reduced incidences of switching due to toxicity and virological failure. |
| format | Article |
| id | doaj-art-fbc278a7bb1f45dea3bacfdc583d76b2 |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-fbc278a7bb1f45dea3bacfdc583d76b22025-08-20T03:10:42ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-0189e7607110.1371/journal.pone.0076071Changes in first-line cART regimens and short-term clinical outcome between 1996 and 2010 in The Netherlands.Mikaela SmitColette SmitSuzanne GeerlingsLuuk GrasKees BrinkmanTimothy B HallettFrank de WolfAthena Observational Cohort<h4>Objectives</h4>Document progress in HIV-treatment in The Netherlands since 1996 by reviewing changing patterns of cART use and relating those to trends in patients' short-term clinical outcomes between 1996 and 2010.<h4>Design and methods</h4>1996-2010 data from 10,278 patients in the Dutch ATHENA national observational cohort were analysed. The annual number of patients starting a type of regimen was quantified. Trends in the following outcomes were described: i) recovery of 150 CD4 cells/mm(3) within 12 months of starting cART; ii) achieving viral load (VL) suppression ≤1,000 copies/ml within 12 months of starting cART; iii) switching from first-line to second-line regimen within three years of starting treatment; and iv) all-cause mortality rate per 100 person-years within three years of starting treatment.<h4>Results</h4>Between 1996 and 2010, first-line regimens changed from lamivudine/zidovudine-based or lamivudine/stavudine-based regimens with unboosted-PIs to tenofovir with either emtricitabine or lamivudine with NNRTIs. Mortality rates did not change significantly over time. VL suppression and CD4 recovery improved over time, and the incidence of switching due to virological failure and toxicity more than halved between 1996 and 2010. These effects appear to be related to the use of new regimens rather than improvements in clinical care.<h4>Conclusion</h4>The use of first-line cART in the Netherlands closely follows changes in guidelines, to the benefit of patients. While there was no significant improvement in mortality, newer drugs with better tolerability and simpler dosing resulted in improved immunological and virological recovery and reduced incidences of switching due to toxicity and virological failure.https://doi.org/10.1371/journal.pone.0076071 |
| spellingShingle | Mikaela Smit Colette Smit Suzanne Geerlings Luuk Gras Kees Brinkman Timothy B Hallett Frank de Wolf Athena Observational Cohort Changes in first-line cART regimens and short-term clinical outcome between 1996 and 2010 in The Netherlands. PLoS ONE |
| title | Changes in first-line cART regimens and short-term clinical outcome between 1996 and 2010 in The Netherlands. |
| title_full | Changes in first-line cART regimens and short-term clinical outcome between 1996 and 2010 in The Netherlands. |
| title_fullStr | Changes in first-line cART regimens and short-term clinical outcome between 1996 and 2010 in The Netherlands. |
| title_full_unstemmed | Changes in first-line cART regimens and short-term clinical outcome between 1996 and 2010 in The Netherlands. |
| title_short | Changes in first-line cART regimens and short-term clinical outcome between 1996 and 2010 in The Netherlands. |
| title_sort | changes in first line cart regimens and short term clinical outcome between 1996 and 2010 in the netherlands |
| url | https://doi.org/10.1371/journal.pone.0076071 |
| work_keys_str_mv | AT mikaelasmit changesinfirstlinecartregimensandshorttermclinicaloutcomebetween1996and2010inthenetherlands AT colettesmit changesinfirstlinecartregimensandshorttermclinicaloutcomebetween1996and2010inthenetherlands AT suzannegeerlings changesinfirstlinecartregimensandshorttermclinicaloutcomebetween1996and2010inthenetherlands AT luukgras changesinfirstlinecartregimensandshorttermclinicaloutcomebetween1996and2010inthenetherlands AT keesbrinkman changesinfirstlinecartregimensandshorttermclinicaloutcomebetween1996and2010inthenetherlands AT timothybhallett changesinfirstlinecartregimensandshorttermclinicaloutcomebetween1996and2010inthenetherlands AT frankdewolf changesinfirstlinecartregimensandshorttermclinicaloutcomebetween1996and2010inthenetherlands AT athenaobservationalcohort changesinfirstlinecartregimensandshorttermclinicaloutcomebetween1996and2010inthenetherlands |